There are multiple Medicare Supplement Claims Processing concerns such as:
- Will the coverage be immediate?
- How about pre-existing conditions?
- How well will the insurance company pay the bills for services received by clients?
Most of them present themselves at the time of replacing one Medigap plan with another.
Medicare Supplement Claims Processing – Common Standards
All these questions are essential for other kinds of insurance but NOT in the world of Medicare Supplement. The reason – all plans are standardized, and claim processing, as well as claim decisions, are identical for all insurance carriers. Under Medicare Supplement, the insured must be covered the day the new policy goes into effect. There can be no waiting period or exclusions for pre-existing conditions, as long as you purchased a Medicare Supplement during an Open Enrollment Period and had at least six months of continuous prior creditable coverage.
Medicare Supplement Claims Processing – Things to Remember
- Medicare provider (i.e., a provider who is in Medicare network) will submit a claim directly to Medicare.
- If the member has a Medicare supplement policy, Medicare will forward the processed claim to the Medigap carrier to process accordingly.
- The Medigap carrier will then look to Medicare to determine eligibility. Let’s assume that the claim is Medicare-eligible. Medicare will pay part of a covered benefit, and the supplement will pay all or part of the remaining claim (based on the deductible, copays, and co-insurance for a given Medigap plan). If the claim is not Medicare-eligible and is not covered by it, the Medicare supplement policy will also NOT pay.
Let Liberty Medicare Help You
If you are looking for Medicare Supplement coverage, Liberty Medicare is here to assist you. We’ll help during the process of comparing, selecting and enrolling in the best and most suitable Medicare Supplement Plan for you. Our services are offered to you at no cost.
Please give us a call at 877-657-7477, or Contact us with your Medicare Questions.